Sec. 11101. Amendments relating to assistance to combat HIV/AIDS, tuberculosis, and malaria

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Subtitle A of title III of the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (22 U.S.C. 7631 et seq.) is amended— by redesignating section 301 as section 301A; in the heading of section 301A (as redesignated), by inserting before other provisions relating to ; and assistance by inserting before section 301A (as redesignated) the following new section: Congress recognizes that the alarming spread of HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, Latin America and other developing countries is a major global health, national security, development, and humanitarian crisis.

It is a major objective of the foreign assistance program of the United States to provide assistance for the prevention and treatment of HIV/AIDS and the care of those affected by the disease. It is the policy objective of the United States, by 2013, to— assist partner countries to— prevent 12,000,000 new HIV infections worldwide; support— the increase in the number of individuals with HIV/AIDS receiving antiretroviral treatment above the goal established under section 402(a)(3) and increased pursuant to paragraphs

(1)through

(3)of section 403(d); and additional treatment through coordinated multilateral efforts; support care for 12,000,000 individuals infected with or affected by HIV/AIDS, including 5,000,000 orphans and vulnerable children affected by HIV/AIDS, with an emphasis on promoting a comprehensive, coordinated system of services to be integrated throughout the continuum of care; provide at least 80 percent of the target population with access to counseling, testing, and treatment to prevent the transmission of HIV from mother-to-child; provide care and treatment services to children with HIV in proportion to their percentage within the HIV-infected population of a given partner country; and train and support retention of health care professionals, paraprofessionals, and community health workers in HIV/AIDS prevention, treatment, and care, with the target of providing such training to at least 140,000 new health care professionals and paraprofessionals with an emphasis on training and in country deployment of critically needed doctors and nurses; strengthen the capacity to deliver primary health care in developing countries, especially in sub-Saharan Africa; support and help countries in their efforts to achieve staffing levels of at least 2.3 doctors, nurses, and midwives per 1,000 population, as called for by the World Health Organization; and help partner countries to develop independent, sustainable HIV/AIDS programs. The United States and other countries with the sufficient capacity should provide assistance to countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, and Latin America, and other countries and regions confronting HIV/AIDS epidemics in a coordinated global strategy to help address generalized and concentrated epidemics through HIV/AIDS prevention, treatment, care, monitoring and evaluation, and related activities. The United States Government’s response to the global HIV/AIDS pandemic and the Government’s efforts to help countries assume leadership of sustainable campaigns to combat their local epidemics should place high priority on— the prevention of the transmission of HIV; moving toward universal access to HIV/AIDS prevention counseling and services; meaningful cost-sharing assurances by the partner country; and the inclusion of transition strategies to ensure sustainability of such programs and activities, including health care systems, under other international donor support, or budget support by respective foreign governments. Consistent with section 1321 of the Global Partnerships Act of 2013 , the President is authorized to furnish assistance, on such terms and conditions as the President may determine, for HIV/AIDS, including to prevent, treat, and monitor HIV/AIDS, and carry out related activities, in countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, Latin America, and other countries and areas, particularly with respect to refugee populations or those in postconflict settings in such countries and areas with significant or increasing HIV incidence rates. It is the sense of Congress that the President should provide an appropriate level of assistance under paragraph

(1)through nongovernmental organizations (including faith-based and community-based organizations) in countries in sub-Saharan Africa, the Caribbean, Central Asia, Eastern Europe, Latin America, and other countries and areas affected by the HIV/AIDS pandemic, particularly with respect to refugee populations or those in post-conflict settings in such countries and areas with significant or increasing HIV incidence rates. The President shall coordinate the provision of assistance under paragraph

(1)with the provision of related assistance by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), the United Nations Development Programme (UNDP), the Global Fund to Fight AIDS, Tuberculosis and Malaria and other appropriate international organizations (such as the International Bank for Reconstruction and Development), relevant regional multilateral development institutions, national, state, and local governments of partner countries, other international actors, appropriate governmental and nongovernmental organizations, and relevant executive branch agencies within the framework of the principles of the Three Ones. Assistance provided under subsection

(c)shall, to the maximum extent practicable, be used to carry out the following activities: Prevention of HIV/AIDS through activities including— programs and efforts that are designed or intended to impart knowledge with the exclusive purpose of helping individuals avoid behaviors that place them at risk of HIV infection, including integration of such programs into health programs and the inclusion in counseling programs of information on methods of avoiding infection of HIV, including delaying sexual debut, abstinence, fidelity and monogamy, reduction of casual sexual partnering and multiple concurrent sexual partnering, reducing sexual violence and coercion, including child marriage, widow inheritance, and polygamy, and where appropriate, use of male and female condoms; assistance to establish and implement culturally appropriate HIV/AIDS education and prevention programs that are designed with local input and focus on helping individuals avoid infection of HIV/AIDS, implemented through nongovernmental organizations, including faith-based and community-based organizations, particularly those locally based organizations that utilize both professionals and volunteers with appropriate skills, experience, and community presence; assistance for the purpose of encouraging men to be responsible in their sexual behavior, child rearing, and to respect women; assistance for the purpose of providing voluntary testing and counseling (including the incorporation of confidentiality protections with respect to such testing and counseling) and promoting the use of provider-initiated or opt-out voluntary testing in accordance with World Health Organization guidelines; assistance for the purpose of preventing mother-to-child transmission of the HIV infection, including medications to prevent such transmission and access to infant formula and other alternatives for infant feeding; assistance to— achieve the goal of reaching 80 percent of pregnant women for prevention and treatment of mother-to-child transmission of HIV in countries in which the United States is implementing HIV/AIDS programs by 2013; and promote infant feeding options and treatment protocols that meet the most recent criteria established by the World Health Organization; medical male circumcision programs as part of national strategies to combat the transmission of HIV/AIDS; assistance to ensure a safe blood supply and sterile medical equipment; assistance to help avoid substance abuse and intravenous drug use that can lead to HIV infection; assistance for the purpose of increasing women’s access to employment opportunities, income, productive resources, and microfinance programs, where appropriate; and assistance for counseling, testing, treatment, care, and support programs, including— counseling and other services for the prevention of reinfection of individuals with HIV/AIDS; counseling to prevent sexual transmission of HIV, including— life skills development for practicing abstinence and faithfulness; reducing the number of sexual partners; delaying sexual debut; and ensuring correct and consistent use of condoms; assistance to engage underlying vulnerabilities to HIV/AIDS, especially those of women and girls; assistance for appropriate HIV/AIDS education programs and training targeted to prevent the transmission of HIV among men who have sex with men; assistance to provide male and female condoms; diagnosis and treatment of other sexually transmitted infections; strategies to address the stigma and discrimination that impede HIV/AIDS prevention efforts; and assistance to facilitate widespread access to microbicides for HIV prevention, if safe and effective products become available, including financial and technical support for culturally appropriate introductory programs, procurement, distribution, logistics management, program delivery, acceptability studies, provider training, demand generation, and postintroduction monitoring. The treatment and care of individuals with HIV/AIDS, including— assistance to establish and implement programs to strengthen and broaden indigenous health care delivery systems and the capacity of such systems to deliver HIV/AIDS pharmaceuticals and otherwise provide for the treatment of individuals with HIV/AIDS, including clinical training for indigenous organizations and health care providers; assistance to strengthen and expand hospice and palliative care programs to assist patients debilitated by HIV/AIDS, their families, and the primary caregivers of such patients, including programs that utilize faith-based and community-based organizations; assistance for the purpose of the care and treatment of individuals with HIV/AIDS through the provision of pharmaceuticals, including antiretrovirals and other pharmaceuticals and therapies for the treatment of opportunistic infections, pain management, nutritional support, and other treatment modalities; as part of care and treatment of HIV/AIDS, assistance (including prophylaxis and treatment) for common HIV/AIDS-related opportunistic infections for free or at a rate at which it is easily affordable to the individuals and populations being served; and as part of care and treatment of HIV/AIDS, assistance or referral to available and adequately resourced service providers for nutritional support, including counseling and where necessary the provision of commodities, for persons meeting malnourishment criteria and their families. With particular emphasis on specific populations that represent a particularly high risk of contracting or spreading HIV/AIDS, including those exploited through the sex trade, victims of rape and sexual assault, individuals already infected with HIV/AIDS, and in cases of occupational exposure of health care workers, assistance with efforts to reduce the risk of HIV/AIDS infection including post-exposure pharmaceutical prophylaxis, and necessary pharmaceuticals and commodities, including test kits, condoms, and, when proven effective, microbicides. Bulk purchases of available test kits, condoms, and, when proven effective, microbicides that are intended to reduce the risk of HIV/AIDS transmission and for appropriate program support for the introduction and distribution of these commodities, as well as education and training on the use of the technologies. The monitoring of programs, projects, and activities carried out pursuant to paragraphs

(1)through (3), including— monitoring to ensure that adequate controls are established and implemented to provide HIV/AIDS pharmaceuticals and other appropriate medicines to poor individuals with HIV/AIDS; appropriate evaluation and surveillance activities; monitoring to ensure that appropriate measures are being taken to maintain the sustainability of HIV/AIDS pharmaceuticals (especially antiretrovirals) and ensure that drug resistance is not compromising the benefits of such pharmaceuticals; monitoring to ensure appropriate law enforcement officials are working to ensure that HIV/AIDS pharmaceuticals are not diminished through illegal counterfeiting or black market sales of such pharmaceuticals; carrying out and expanding program monitoring, impact evaluation research and analysis, and operations research and disseminating data and findings through mechanisms to be developed by the Coordinator of United States Government Activities to Combat HIV/AIDS Globally, in coordination with the Director of the Centers for Disease Control, in order to— improve accountability, increase transparency, and ensure the delivery of evidence-based services through the collection, evaluation, and analysis of data regarding gender-responsive interventions, disaggregated by age and sex; identify and replicate effective models; and develop gender indicators to measure outcomes and the impacts of interventions; and establishing appropriate systems to— gather epidemiological and social science data on HIV; and evaluate the effectiveness of prevention efforts among men who have sex with men, with due consideration to stigma and risks associated with disclosure. The procurement of HIV/AIDS pharmaceuticals, antiviral therapies, and other appropriate medicines, including medicines to treat opportunistic infections. Mechanisms to ensure that such HIV/AIDS pharmaceuticals, antiretroviral therapies, and other appropriate medicines are quality-controlled and sustainably supplied. Subject to subparagraph (B), mechanisms to ensure that safe and effective pharmaceuticals, including antiretrovirals and medicines to treat opportunistic infections, are purchased at the lowest possible price at which such pharmaceuticals may be obtained in sufficient quantity on the world market, provided that such pharmaceuticals are approved, tentatively approved, or otherwise authorized for use by— the Food and Drug Administration; a stringent regulatory agency acceptable to the Secretary of Health and Human Services; or a quality assurance mechanism acceptable to the Secretary of Health and Human Services. The distribution of such HIV/AIDS pharmaceuticals, antiviral therapies, and other appropriate medicines (including medicines to treat opportunistic infections) to qualified national, regional, or local organizations for the treatment of individuals with HIV/AIDS in accordance with appropriate HIV/AIDS testing and monitoring requirements and treatment protocols and for the prevention of mother-to-child transmission of the HIV infection. The conduct of related activities, including— the care and support of children who are orphaned by the HIV/AIDS pandemic, including services designed to care for orphaned children in a family environment which rely on extended family members; improved infrastructure and institutional capacity to develop and manage education, prevention, and treatment programs, including training and the resources to collect and maintain accurate HIV surveillance data to target programs and measure the effectiveness of interventions; vaccine research and development partnership programs with specific plans of action to develop a safe, effective, accessible, preventive HIV vaccine for use throughout the world; coordinated or referred activities to— enhance the clinical impact of HIV/AIDS care and treatment; and ameliorate the adverse social and economic costs often affecting AIDS-impacted families and communities through the direct provision, as necessary, or through the referral, if possible, of support services, including— nutritional and food support; safe drinking water and adequate sanitation; nutritional counseling; income-generating activities and livelihood initiatives; maternal and child health care; primary health care; the diagnosis and treatment of other infectious or sexually transmitted diseases; substance abuse and treatment services; and legal services; coordinated or referred activities to link programs addressing HIV/AIDS with programs addressing gender-based violence in areas of significant HIV prevalence to assist countries in the development and enforcement of women’s health, children’s health, and HIV/AIDS laws and policies that— prevent and respond to violence against women and girls; promote the integration of screening and assessment for gender-based violence into HIV/AIDS programming; promote appropriate HIV/AIDS counseling, testing, and treatment into gender-based violence programs; and assist governments to develop partnerships with civil society organizations to create networks for psychosocial, legal, economic, or other support services; coordinated or referred activities to— address the frequent coinfection of HIV and tuberculosis, in accordance with World Health Organization guidelines; promote provider-initiated or opt-out HIV/AIDS counseling and testing and appropriate referral for treatment and care to individuals with tuberculosis or its symptoms, particularly in areas with significant HIV prevalence; and strengthen programs to ensure that individuals testing positive for HIV receive tuberculosis screening and to improve laboratory capacities, infection control, and adherence; and activities to— improve the effectiveness of national responses to HIV/AIDS; strengthen overall health systems in high-prevalence countries, including support for workforce training, retention, and effective deployment, capacity building, laboratory development, equipment maintenance and repair, and public health and related public financial management systems and operations; encourage fair and transparent procurement practices among partner countries; and promote in-country or intra-regional pediatric training for physicians and other health professionals, preferably through public-private partnerships involving colleges and universities, with the goal of increasing pediatric HIV workforce capacity. The establishment and operation of public-private partnership entities within countries in sub-Saharan Africa, the Caribbean, and other countries affected by the HIV/AIDS pandemic that are dedicated to supporting the national strategy of such countries regarding the prevention, treatment, and monitoring of HIV/AIDS. Each such public-private partnership should— support the development, implementation, and management of comprehensive HIV/AIDS plans in support of the national HIV/AIDS strategy; operate at all times in a manner that emphasizes efficiency, accountability, and results-driven programs; engage both local and foreign development partners and donors, including businesses, government agencies, academic institutions, nongovernmental organizations, foundations, multilateral development agencies, and faith-based organizations, to assist the country in coordinating and implementing HIV/AIDS prevention, treatment, and monitoring programs in accordance with its national HIV/AIDS strategy; provide technical assistance, consultant services, financial planning, monitoring and evaluation, and research in support of the national HIV/AIDS strategy; and establish local human resource capacities for the national HIV/AIDS strategy through the transfer of medical, managerial, leadership, and technical skills. The development of compacts or framework agreements, tailored to local circumstances, with national governments or regional partnerships in countries with significant HIV/AIDS burdens to promote host government commitment to deeper integration of HIV/AIDS services into health systems, contribute to health systems overall, and enhance sustainability, including— meaningful cost-sharing assurances by the partner country; and transition strategies to ensure sustainability of such programs and activities, including health care systems, under other international donor support, or budget support by respective foreign governments. Congress makes the following findings: The congressionally mandated Institute of Medicine report entitled PEPFAR Implementation: Progress and Promise states: The next strategy [of the U.S. Global AIDS Initiative] should squarely address the needs and challenges involved in supporting sustainable country HIV/AIDS programs, thereby transitioning from a focus on emergency relief. . One mechanism to promote the transition from an emergency to a public health and development approach to HIV/AIDS is through compacts or framework agreements between the United States Government and each participating nation. Compacts on HIV/AIDS authorized under subsection (d)(8) shall include the following elements: Compacts whose primary purpose is to provide direct services to combat HIV/AIDS are to be made between— the United States Government; and national or regional entities representing low-income countries served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform; or countries or regions— experiencing significantly high HIV prevalence or risk of significantly increasing incidence within the general population; served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform; and that have inadequate financial means within such country or region. Compacts whose primary purpose is to provide limited technical assistance to a country or region connected to services provided within the country or region— may be made with other countries or regional entities served by an existing United States Agency for International Development or Department of Health and Human Services presence or regional platform; shall require significant investments in HIV prevention, care, and treatment services by the host country; shall be time-limited in terms of United States contributions; and shall be made only upon prior notification to Congress— justifying the need for such compacts; describing the expected investment by the country or regional entity; and describing the scope, nature, expected total United States investment, and time frame of the limited technical assistance under the compact and its intended impact. Compacts shall include provisions to— promote local and national efforts to reduce stigma associated with HIV/AIDS; and work with and promote the role of civil society in combating HIV/AIDS. Compacts shall take into account the overall national health and development and national HIV/AIDS and public health strategies of each country. Compacts shall contain— consideration of the specific objectives that the country and the United States expect to achieve during the term of a compact; consideration of the respective responsibilities of the country and the United States in the achievement of such objectives; consideration of regular benchmarks to measure progress toward achieving such objectives; an identification of the intended beneficiaries, disaggregated by gender and age, and including information on orphans and vulnerable children, to the maximum extent practicable; consideration of the methods by which the compact is intended to— address the factors that put women and girls at greater risk of HIV/AIDS; and strengthen elements such as the economic, educational, and social status of women, girls, orphans, and vulnerable children and the inheritance rights and safety of such individuals; consideration of the methods by which the compact will— strengthen the health care capacity, including factors such as the training, retention, deployment, recruitment, and utilization of health care workers; improve supply chain management; and improve the health systems and infrastructure of the partner country, including the ability of compact participants to maintain and operate equipment transferred or purchased as part of the compact; consideration of proposed mechanisms to provide oversight; consideration of the role of civil society in the development of a compact and the achievement of its objectives; a description of the current and potential participation of other donors in the achievement of such objectives, as appropriate; and consideration of a plan to ensure appropriate fiscal accountability for the use of assistance. For regional compacts, priority shall be given to countries that are included in regional funds and programs in existence as of the date of the enactment of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008. Amounts made available for compacts described in subparagraphs

(A)and

(B)shall be subject to the inclusion of— meaningful cost-sharing assurances by the partner country; and transition strategies to ensure sustainability of such programs and activities, including health care systems, under other international donor support, and budget support by respective foreign governments. In entering into a compact on HIV/AIDS authorized under subsection (d)(8), the Coordinator of United States Government Activities to Combat HIV/AIDS Globally shall seek to ensure that the government of a country— takes into account the local perspectives of the rural and urban poor, including women, in each country; and consults with private and voluntary organizations, including faith-based organizations, the business community, and other donors in the country. Not later than 10 days after entering into a compact authorized under subsection (d)(8), the Global AIDS Coordinator shall— submit a report containing a detailed summary of the compact and a copy of the text of the compact to— the Committee on Foreign Relations of the Senate; the Committee on Appropriations of the Senate; the Committee on Foreign Affairs of the House of Representatives; and the Committee on Appropriations of the House of Representatives; and publish such information in the Federal Register and on the Internet website of the Office of the Global AIDS Coordinator. Not later than January 31 of each year, the President shall submit to the Committee on Foreign Relations of the Senate and the Committee on Foreign Affairs of the House of Representatives a report on the implementation of this section for the prior fiscal year. Each report shall include— a description of efforts made by each relevant executive branch agency to implement the policies set forth in this section, section 302, and section 303; a description of the programs established pursuant to such sections; a detailed breakdown of funding allocations, by program and by country, for prevention activities; and a detailed assessment of the impact of programs established pursuant to such sections, including— the effectiveness of such programs in reducing— the transmission of HIV, particularly in women and girls; mother-to-child transmission of HIV, including through drug treatment and therapies, either directly or by referral; and mortality rates from HIV/AIDS; the number of patients receiving treatment for AIDS in each country that receives assistance under this Act; an assessment of progress towards the achievement of annual goals set forth in the timetable required under the 5-year strategy established under section 101 and, if annual goals are not being met, the reasons for such failure; and retention and attrition data for programs receiving United States assistance, including mortality and loss to follow-up rates, organized overall and by country; the progress made toward— improving health care delivery systems (including the training of health care workers, including doctors, nurses, midwives, pharmacists, laboratory technicians, and compensated community health workers, and the use of codes of conduct for ethical recruiting practices for health care workers); advancing safe working conditions for health care workers; and improving infrastructure to promote progress toward universal access to HIV/AIDS prevention, treatment, and care by 2013; a description of coordination efforts with relevant executive branch agencies to link HIV/AIDS clinical and social services with non-HIV/AIDS services as part of the United States health and development agenda; a detailed description of integrated HIV/AIDS and food and nutrition programs and services, including— the amount spent on food and nutrition support; the types of activities supported; and an assessment of the effectiveness of interventions carried out to improve the health status of persons with HIV/AIDS receiving food or nutritional support; a description of efforts to improve harmonization, in terms of relevant executive branch agencies, coordination with other public and private entities, and coordination with partner countries’ national strategic plans as called for in the Three Ones ; a description of— the efforts of partner countries that were signatories to the Abuja Declaration on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases to adhere to the goals of such Declaration in terms of investments in public health, including HIV/AIDS; and a description of the HIV/AIDS investments of partner countries that were not signatories to such Declaration; a detailed description of any compacts or framework agreements reached or negotiated between the United States and any partner countries, including a description of the elements of compacts described in subsection (e); a description of programs serving women and girls, including— HIV/AIDS prevention programs that address the vulnerabilities of girls and women to HIV/AIDS; information on the number of individuals served by programs aimed at reducing the vulnerabilities of women and girls to HIV/AIDS and data on the types, objectives, and duration of programs to address these issues; information on programs to address the particular needs of adolescent girls and young women; and programs to prevent gender-based violence or to assist victims of gender based violence as part of, or in coordination with, HIV/AIDS programs; a description of strategies, goals, programs, and interventions to— address the needs and vulnerabilities of youth populations; expand access among young men and women to evidence-based HIV/AIDS health care services and HIV prevention programs, including abstinence education programs; and expand community-based services to meet the needs of orphans and of children and adolescents affected by or vulnerable to HIV/AIDS without increasing stigmatization; a description of— the specific strategies funded to ensure the reduction of HIV infection among injection drug users; the number of injection drug users, by country, reached by such strategies; and medication-assisted drug treatment for individuals with HIV or at risk of HIV; a detailed description of program monitoring, operations research, and impact evaluation research, including— the amount of funding provided for each research type; an analysis of cost-effectiveness models; and conclusions regarding the efficiency, effectiveness, and quality of services as derived from previous or ongoing research and monitoring efforts; building capacity to identify, investigate, and stop nosocomial transmission of infectious diseases, including HIV and tuberculosis; and a description of staffing levels of United States Government HIV/AIDS teams in countries with significant HIV/AIDS programs, including whether or not a full-time coordinator was on staff for the year. Of the funds made available to carry out this section in any fiscal year, not more than 7 percent may be used for the administrative expenses of the United States Agency for International Development in support of activities described in this section, section 302, and section 303. Such amount shall be in addition to other amounts otherwise available for such purposes. In this section: The term AIDS means acquired immune deficiency syndrome. The term HIV means the human immunodeficiency virus, the pathogen that causes AIDS. The term HIV/AIDS means, with respect to an individual, an individual who is infected with HIV or living with AIDS. The term relevant executive branch agencies means the Department of State, the United States Agency for International Development, the Department of Health and Human Services (including its agencies and offices), and any other department or agency of the United States that participates in international HIV/AIDS activities pursuant to the authorities of such department or agency or this Act. . Subtitle A of title III of the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 ( 22 U.S.C. 7631 et seq. ) is amended— by redesignating section 302 as section 302A; in the heading of section 302A (as redesignated), by inserting before other provisions relating to ; and assistance by inserting before section 302A (as redesignated) the following new section: Congress makes the following findings: Congress recognizes the growing international problem of tuberculosis and the impact its continued existence has on those countries that had previously largely controlled the disease. Congress further recognizes that the means exist to control and treat tuberculosis through expanded use of the DOTS (Directly Observed Treatment Short-course) treatment strategy, including DOTS–Plus to address multi-drug resistant tuberculosis, and adequate investment in newly created mechanisms to increase access to treatment, including the Global Tuberculosis Drug Facility established in 2001 pursuant to the Amsterdam Declaration to Stop TB and the Global Alliance for TB Drug Development. It is a major objective of the foreign assistance program of the United States to control tuberculosis. In all countries in which the Government of the United States has established development programs, particularly in countries with the highest burden of tuberculosis and other countries with high rates of tuberculosis, the United States should support the objectives of the Global Plan to Stop TB, including through achievement of the following goals: Reduce by half the tuberculosis death and disease burden from the 1990 baseline. Sustain or exceed the detection of at least 70 percent of sputum smear-positive cases of tuberculosis and the successful treatment of at least 85 percent of the cases detected in countries with established United States Agency for International Development tuberculosis programs. In support of the Global Plan to Stop TB, the President shall establish a comprehensive, 5-year United States strategy to expand and improve United States efforts to combat tuberculosis globally, including a plan to support— the successful treatment of 4,500,000 new sputum smear tuberculosis patients under DOTS programs by 2013, primarily through direct support for needed services, commodities, health workers, and training, and additional treatment through coordinated multilateral efforts; and the diagnosis and treatment of 90,000 new multiple drug resistant tuberculosis cases by 2013, and additional treatment through coordinated multilateral efforts. To carry out this section and consistent with section 1321 of the Global Partnerships Act of 2013 , the President is authorized to furnish assistance, on such terms and conditions as the President may determine, for the prevention, treatment, control, and elimination of tuberculosis. In carrying out this section, the President shall coordinate with the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and other organizations with respect to the development and implementation of a comprehensive tuberculosis control program. In furnishing assistance under subsection (c), the President shall give priority to— direct services described in the Stop TB Strategy, including expansion and enhancement of Directly Observed Treatment Short-course

(DOTS)coverage, rapid testing, treatment for individuals infected with both tuberculosis and HIV, and treatment for individuals with multi-drug resistant tuberculosis (MDR–TB), strengthening of health systems, use of the International Standards for Tuberculosis Care by all providers, empowering individuals with tuberculosis, and enabling and promoting research to develop new diagnostics, drugs, and vaccines, and program-based operational research relating to tuberculosis; and funding for the Global Tuberculosis Drug Facility, the Stop Tuberculosis Partnership, and the Global Alliance for TB Drug Development. In carrying out this section, the President, acting through the Administrator of the United States Agency for International Development, is authorized to provide increased resources to the World Health Organization and the Stop Tuberculosis Partnership to improve the capacity of countries with high rates of tuberculosis and other affected countries to implement the Stop TB Strategy and specific strategies related to addressing multiple drug resistant tuberculosis (MDR–TB) and extensively drug resistant tuberculosis (XDR–TB). The President shall submit an annual report to Congress that describes the impact of United States foreign assistance on efforts to control tuberculosis, including— the number of tuberculosis cases diagnosed and the number of cases cured in countries receiving United States bilateral foreign assistance for tuberculosis control purposes; a description of activities supported with United States tuberculosis resources in each country, including a description of how those activities specifically contribute to increasing the number of people diagnosed and treated for tuberculosis; in each country receiving bilateral United States foreign assistance for tuberculosis control purposes, the percentage provided for direct tuberculosis services in countries receiving United States bilateral foreign assistance for tuberculosis control purposes; a description of research efforts and clinical trials to develop new tools to combat tuberculosis, including diagnostics, drugs, and vaccines supported by United States bilateral assistance; the number of persons who have been diagnosed and started treatment for multidrug-resistant tuberculosis in countries receiving United States bilateral foreign assistance for tuberculosis control programs; a description of the collaboration and coordination of United States anti-tuberculosis efforts with the World Health Organization, the Global Fund, and other major public and private entities within the Stop TB Strategy; the constraints on implementation of programs posed by health workforce shortages and capacities; the number of people trained in tuberculosis control; and a breakdown of expenditures for direct patient tuberculosis services, drugs and other commodities, drug management, training in diagnosis and treatment, health systems strengthening, research, and support costs. In this section: The term DOTS or Directly Observed Treatment Short-course means the World Health Organization-recommended strategy for treating tuberculosis, including— low-cost and effective diagnosis, treatment, and monitoring of tuberculosis; a reliable drug supply; a management strategy for public health systems; health system strengthening; promotion of the use of the International Standards for Tuberculosis Care by all care providers; bacteriology under an external quality assessment framework; short-course chemotherapy; and sound reporting and recording systems. P lus The term DOTS–Plus means a comprehensive tuberculosis management strategy that is built upon and works as a supplement to the standard DOTS strategy, and which takes into account specific issues (such as use of second line anti-tuberculosis drugs) that need to be addressed in areas where there is high prevalence of multidrug resistant tuberculosis. The term Global Alliance for Tuberculosis Drug Development means the public-private partnership that brings together leaders in health, science, philanthropy, and private industry to devise new approaches to tuberculosis and to ensure that new medications are available and affordable in high tuberculosis burden countries and other affected countries. The term Stop TB Strategy means the 6-point strategy to reduce tuberculosis developed by the World Health Organization, which is described in the Global Plan to Stop TB 2006–2015: Actions for Life, a comprehensive plan developed by the Stop TB Partnership that sets out the actions necessary to achieve the millennium development goal of cutting tuberculosis deaths and disease burden in half by 2015. The term Stop Tuberculosis Partnership means the partnership of the World Health Organization, donors including the United States, high tuberculosis burden countries, multilateral agencies, and nongovernmental and technical agencies committed to short- and long-term measures required to control and eventually eliminate tuberculosis as a public health problem in the world. . Subtitle A of title III of the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 ( 22 U.S.C. 7631 et seq. ) is amended— by redesignating section 303 as section 303A; in the heading of section 303A (as redesignated), by inserting before other provisions relating to ; and assistance by inserting before section 303A (as redesignated) the following new section: Congress finds that malaria kills more people annually than any other communicable disease except tuberculosis, that more than 90 percent of all malaria cases are in sub-Saharan Africa, and that children and women are particularly at risk. Congress recognizes that there are cost-effective tools to decrease the spread of malaria and that malaria is a curable disease if promptly diagnosed and adequately treated. It is a major objective of the foreign assistance program of the United States to provide assistance for the prevention, control, treatment, and cure of malaria. To carry out this section and consistent with section 1321 of the Global Partnerships Act of 2013 , the President is authorized to furnish assistance, on such terms and conditions as the President may determine, for the prevention, treatment, control, and elimination of malaria. In carrying out this section, the President shall coordinate with the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the Department of Health and Human Services (the Centers for Disease Control and Prevention and the National Institutes of Health), and other organizations with respect to the development and implementation of a comprehensive malaria control program. . The United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 ( 22 U.S.C. 7601 et seq. ) is amended— in section 3(12), by striking Foreign Assistance Act of 1961 and inserting Global Partnerships Act of 2013 ; in section 101(f)(1)(A), by inserting at the end before the period the following: (as such sections were in effect on the day before the date of the enactment of the Global Partnerships Act of 2013) ; in section 202(d)(4)(B)— in clause (iii), by striking section 104A of the Foreign Assistance Act of 1961 (as added by section 301 of this Act) and inserting section 301 of this Act ; and in clause (iv), by striking sections 104A, 104B, and 104C of the Foreign Assistance Act of 1961 (as added by title III of this Act) and inserting sections 301, 302, and 303 of this Act ; in section 204(b)(1), by striking section 129 of the Foreign Assistance Act of 1961 ( and inserting 22 U.S.C. 2152 ) section 1132 of the Global Partnerships Act of 2013 ; in section 301A (as redesignated)— in subsection (b)— in paragraph (1)— by striking section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) and inserting section 1304 of the Global Partnerships Act of 2013 ; and by striking section 104A of the Foreign Assistance Act of 1961, as added by subsection

(a)and inserting section 301 ; and in paragraph (3), by striking section 104A(d)(4) of the Foreign Assistance Act of 1961 (as added by subsection (a)) and inserting section 301(d)(5) ; and in subsection (d), by striking under section 104A of the Foreign Assistance Act of 1961 and inserting under section 1304 of the Global Partnerships Act of 2013 ; in section 302A(b)(1) (as redesignated)— by striking section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) and inserting section 1304 of the Global Partnerships Act of 2013 ; and by striking section 104B of the Foreign Assistance Act of 1961, as added by subsection

(a)and inserting section 302 ; and in section 303A(b)(1) (as redesignated)— by striking section 104(c) of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b(c)) and inserting section 1304 of the Global Partnerships Act of 2013 ; and by striking section 104C of the Foreign Assistance Act of 1961, as added by subsection

(a)and inserting section 303 ; in section 304A (as redesignated)— in subsection (e), by striking section 104C of the Foreign Assistance Act of 1961 (22 U.S.C. 2151b–4) and inserting section 303 ; and in subsection (f), by striking section 104C ; in section 312(c)(4)(C)(ii), by striking 104A(f) of the Foreign Assistance Act of 1961 and inserting section 301(f) ; and in section 403— in subsection (a)(4), by striking section 104A(e) of the Foreign Assistance Act of 1961 ( and inserting 22 U.S.C. 2151b–2(e) ) section 301(e) of this Act ; and in subsection (d)(4), by striking section 104A(b)(1)(A) of the Foreign Assistance Act of 1961 ( and inserting 22 U.S.C. 2151b–2(b)(1)(A) ) section 301(b)(1)(A) of this Act . The table of contents in section 1(b) of the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 ( 22 U.S.C. 7601 note) is amended by striking the items relating to sections 301 through 303 and inserting the following new items: Sec. 301. Assistance to combat HIV/AIDS. Sec. 301A. Other provisions relating to assistance to combat HIV/AIDS. Sec. 302. Assistance to combat tuberculosis. Sec. 302A. Other provisions relating to assistance to combat tuberculosis. Sec. 303. Assistance to combat malaria. Sec. 303A. Other provisions relating to assistance to combat malaria. . Unobligated balances of funds made available under sections 104A, 104B and 104C of the Foreign Assistance Act of 1961 (as in effect on the day before the date of the enactment of this Act) shall be transferred to, merged with, and made available for the same purposes as funds made available under sections 301, 302 and 303, respectively, of the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (as added by this section).

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